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Degenerative Severe Aortic Stenosis managed by ‘Trans Aortic Valve Replacement (TAVR)’ in a Covid recovered octogenarian!

83-year-old male patient from West Godavari District, suffering from Hypertension, Mild Coronary Artery Disease, COPD Presented to Apollo Hospitals with a history of Palpitations, Breathlessness- FC-II, Mild Chest Pain. On evaluation, he was found to have severe Degenerative Aortic Valve Disease-severe Aortic Stenosis and Mild Aortic Regurgitation. He had an immediate past history of COVID infection two months back leading to some lung fibrosis and worsening of breathlessness, palpitations and extreme fatigue. He was rushed to the hospital considering his deteriorating condition due to pre-existing severe Aortic valve disease coupled with the post COVID difficulties.

The patient was evaluated further with HR CT Chest for COVID manifestations, stabilized and once COVID PCR became negative he was evaluated by CT Angio with TAVR Protocol (Fig-1). A detailed clinical and Echocardiogram evaluation (Fig-2) that followed was discussed in Heart Team and has strongly recommended TAVR (Fig 3) as the treatment option. His Coronary Angiogram revealed mild CAD which was decided to be managed medically. After explaining the pros and Cons regarding TAVR, the patient was admitted on 25th November and the TAVR procedure was done successfully. The post-procedure hemodynamic revealed no gradient across the Aortic valve and echo did show good valve position with no AR. His Femoral puncture site was closed with Perclose- Proglide systems. The patient was ambulatory by night and was discharged the next day morning. This is the first patient in the twin Telugu states to undergo this procedure post-COVID recovery, even in the Country, no data was available on this being performed earlier.

This performing of a TAVR procedure on an octogenarian COVID recovered patient is a milestone. It sends a strong message to patients with pre-existing cardiac disease and recovered from COVID, that there is no need to postpone seeking medical care for critical ailments. The expertise and facilities available at Apollo Hospitals can help patients recover from serious ailments and lead a normal and active life again.

Dr A Sreenivas Kumar
MBBS, MD(Gen Med), DM(Cardio)SGPGI, FACC(USA)
 Director, Cardiology & Clinical Research,
Apollo Hospitals, Jubilee Hills, Hyderabad, India

Dr Gokul Reddy Mandala
DM, MD, FACC
Senior Consultant Cardiologist,
Apollo Hospitals, Jubilee Hills, Hyderabad, India

Dr Sanjeev Kumar Khulbey
MBBS; MS (General Surgery); MCh
Senior Consultant Cardiologist
Apollo Hospitals, Jubilee Hills, Hyderabad, India

Dr Ramakrishna Janapati
DM(Cardiology), MD(General Medicine), MBBS
Consultant Cardiologist
Apollo Hospitals, Jubilee Hills, Hyderabad, India

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